Chemotherapy between the first and second stages of a two-stage hepatectomy for colorectal liver metastases: Should we routinely recommend it?

Background. The aim of the present study is to examine the effect of systemic chemotherapy after the 1st-stage hepatectomy (CTx2) on the progression of disease and dropout rates. A major pitfall of the 2-stage hepatectomy procedure is a high dropout rate after the 1st-stage hepatectomy due to progression of disease (PD). Routine use of CTx2 has been advocated. Methods. A total of 47 patients with multiple, bilateral unresectable liver metastases were selected for a 2-stage hepatectomy procedure (±portal vein occlusion). Results. Of the total, 37 patients (78.7%) underwent systemic chemotherapy before the 1st-stage hepatectomy (CTx1) and 25 patients (53.2%) underwent CTx2; PD was significantly more common during CTx2 than during CTx1 (P = .002). Of the 47 patients planned for the 2nd-stage hepatectomy, 36 (76.6%) completed the procedure. Of these 47 patients, 25 (53.2%) showed PD after the 1st-stage hepatectomy, 12 in the CTx2 group and 13 in the no-CTx2 group; administration of CTx2 did not significantly affect the PD rate (P = .561). The overall dropout rate was 23.4% (n = 11 patients): 16% in the CTx2 group vs. 31.8% in the no-CTx2 group (P = .303). Conclusions. The routine use of chemotherapy between the 1st- and 2nd-stage hepatectomy does not guarantee lower PD and dropout rates.